- Sedgwick (Dayton, OH)
- …clients. + Participates in claim recoveries including, but not limited to: subrogation , Second Injury Fund recoveries, and Social Security offsets. + Communicates ... claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact. + Ensures claims files are properly documented and claims coding is correct. + Maintains… more
- Elevance Health (OH)
- …appropriate. + Identifies and refers cases or issues to QI, SIU, Subrogation , Underwriting, or other departments as appropriate. + Documents appropriate clinical ... information, decisions, and determinations in a timely, accurate, and concise manner. + Develops a working knowledge of member benefits, contracts, medical policy, professional standards of practice, and current health care practices. Position requirements: +… more
- Medical Mutual of Ohio (OH)
- …functions within Finance areas such as group billing, unclaimed funds, subrogation , and national network arrangements. + Analyzes general ledger account activity ... compared to prior period and/or forecast.Researches and explains variances. + Reconciles complex general ledger accounts ensuring the accuracy of reported balances.Researches any reconciling items and takes necessary action to correct these items. + Assists in… more
- First Student (Cincinnati, OH)
- …(eg, attorneys, independent adjusters, experts). + Identify and pursue subrogation , contribution, and SIU opportunities. + Negotiate and resolve non-complex ... claims, including litigated matters, within authority limits. + Refer cases outside of authority level with appropriate documentation. + Support the development and refinement of claims management procedures. _PIP Claims Examination_ + Review and analyze… more
- Molina Healthcare (Cleveland, OH)
- …+ Health claims processing background, including coordination of benefits, subrogation , and eligibility criteria. + Familiarity with Medicaid and Medicare ... claims denials and appeals processing, and knowledge of regulatory guidelines for Provider No Surprises Act cases + Strong verbal and written communication skills **PREFERRED EXPERIENCE:** + No Surprise Act Provider Disputes knowledge/experience To all current… more
- Sedgwick (Columbus, OH)
- …the file towards prompt and appropriate resolution. + Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. + ... Communicates claim action/processing with insured, client, and agent or broker when appropriate. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required.… more
- Sedgwick (Seven Hills, OH)
- …file towards prompt and appropriate resolution. + Identifies and pursues subrogation opportunities; secures and disposes of salvage. + Communicates claim ... action/processing with insured, client, and agent or broker when appropriate. + Maintains professional client relations. + Performs coverage, liability, and damage analysis on all claims assignments. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs… more
- USAA (Cincinnati, OH)
- …resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics. + Identifies coverage ... concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing information involving complex policy terms and contingencies. + Determines and negotiates complex… more
- Sedgwick (Columbus, OH)
- …cost for our clients. + Identifies and investigates for possible fraud, subrogation , contribution, recovery, and case management opportunities to reduce total claim ... cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is… more
- Sedgwick (Cincinnati, OH)
- …Issues settlement checks, files regulatory documents, and handles salvage and subrogation as applicable. + Recommends litigation by legal department when settlement ... cannot be negotiated. + Attends litigation hearings and participates in depositions as necessary. + Revises case reserves in assigned claims files to cover probable costs. + Maintains an expected caseload efficiently. + Utilizes technology and automation tools… more